Exploring the New Era of Individualized Treatment Through Science, Technology and Integrated Medicine

Precision medicine has grown to rest on three overarching themes – classify disease more precisely, treat patients on individual scale, and guide public prevention measures. Perhaps we have witnessed no greater progress in precision medicine than in oncology and cancer research. In this meeting description, we highlight recent advances and future perspectives on three major disciplines of cancer research: drug discovery, cancer biomarker development, and "omic" technologies.

Drug development often starts with the classification and understanding of disease processes, followed by target identification and lead compound discovery. Thanks to advances in technology, disease classification in cancer has moved away from the classical symptom-based taxonomy and towards molecular-based data involving DNA, RNA, and proteins. Anti-cancer drugs like Trastuzumab target cancer cells, based on receptors uniquely found on cancer cell surface. Large-scale characterization studies on cancer will hopefully identify key drugable targets. As we continue to develop and validate investigational compounds, our everlasting goal will be to match targeted therapies with patients based on a cancer's unique genetic makeup.

A biomarker is a biological molecule that objectively measures normal or diseased state in an organism. Cancer biomarkers can be broadly classified into three categories: predictive to forecast response of a therapeutic intervention, prognostic to inform physicians risk of clinical outcome, and diagnostic to identify a patient with specific disease. The HER2 gene has become an influential biomarker in precision medicine. Breast cancer patients positive for HER2 expression show improved survival when treated with anti-HER2 therapy, Trastuzumab. As we develop novel drugs for personalized precision care, biomarkers will play a critical tool in providing objective data to track how patients react or benefit from therapies. Biomarkers will also identify patients at risk of cancer long before the cancer develops to affect human body.

Rapid developments in high-throughput technology and computational frameworks have enabled the development of several -omics disciplines. For genomics, collaborative efforts like The Cancer Genome Atlas have led to complete sequencing of several types of cancers. Pharmacogenomics has also gained momentum. Thanks to studies confirming genetic variations can cause difference in how the body metabolizes drugs, the FDA requires genetic testing for cancer patients prior to administration of several monoclonal therapies. Metabolomics is yet another field with important consequences. Researchers are working on validating endogenous small-molecule biochemicals (metabolites) within biologic systems. In turn, various fluids (blood and urine) can be used to validate metabolic biomarkers noninvasively in patients. Further studies will hopefully improve exposure measures and delineate mechanistic links between various exposures and cancer.

Despite numerous challenges in past, successful individualized therapies and applications have been achieved. Acknowledging unclear future prospects ahead, all stakeholders must work together to fulfill the vision and promise of Precision Medicine.